4. Basic Life Support in the Collapsed Infant and Child 2020.pptx

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1. Basic Life Support in the Collapsed Infant and Child ETAT+ Sierra Leone 2020

2. Learning Objectives At the end of the session you will be able to: Identify the importance of anticipating and preventing collapse responding quickly to collapse Use the structured approach to the collapsed child (in cardiac or respiratory arrest)

3. Emergency care in hospital What is the most important factor in success?

4. Being prepared Staff who is in the team how are they alerted Setting for delivering support special area at the bedside Equipment responsibility for provision and maintenance Knowledge training guidelines orientation and awareness

5. Emergency care in hospital What is the most important factor in saving lives? PREVENTION Early recognition of severe illness Preventive action

6. Most common causes of collapse in children Respiratory failure e.g. Pneumonia Circulatory failure (shock) Severe anaemia Dehydration Septic shock Heart failure

7. The collapsed child - a structured approach SSSS Safety Stimulate the child – if they are not obviously responsive Shout for help Setting A Airway B Breathing C Circulation

8. Resuscitation - Airway Is the airway Clear Obstructed At risk Look in the mouth vomit/secretions Position the airway neutral in infant < 1yr sniffing in child ≥ 1 yr

9. If there is an Airway problem – fix it immediately! Suction Airway opening manoeuvres Position (neutral/sniffing) Chin lift Jaw thrust (if two people) Airway adjuncts Oropharyngeal Nasopharyngeal

10. Resuscitation – check for Breathing After positioning Look Chest movement Listen Stridor Secretions Noises of breathing Feel Air movement on your cheek

11. Resuscitation – Airway and Breathing Open + clear the Airway Look + listen + feel for Breathing Check adequacy of breathing and need for oxygen BREATHING ABSENT/ INADEQUATE BREATHING 5 breaths with bag-valve-mask (BVM)

12. Effective bag and mask ventilation

13. Resuscitation – Breathing ABSENT/INADEQUATE BREATHING 5 breaths with bag-valve-mask Select appropriate mask & ensure good seal 1 second inspiration,1 second expiration Look at chest movement Attach oxygen to BVM as soon as possible The chest must rise well at least twice Open + clear the Airway Look + listen + feel for Breathing

14. If chest wall does not rise at least twice Reposition the head Review position and seal of the mask Consider 2-person technique Consider passing a nasogastric tube and aspirate if too much air in stomach after lots of bag valve mask ventilation

15. Resuscitation - Circulation 5 breaths with bag-valve-mask Re-assess airway & breathing while check large pulse Continue BVM breaths with oxygen 20 breaths/min for 2 min Then reassess ABC Heart rate ≥ 60/min, not breathing Heart rate very slow < 60/min Help is needed

16. Resuscitation - Circulation 5 breaths with bag-valve-mask Re-assess airway & breathing while check large pulse Heart rate very slow < 60/min, no breathing 15 chest compressions (100-120/min) to 2 breaths Aim for 6–7 cycles of 15:2 per minute Every 2 minutes, check for pulse or signs of life

17. Chest compressions Lower 1/3 of sternum (avoid xiphisternum ) In the midline Compress the chest by 1/3 of its depth Equal time for compression & relaxation Firm, flat surface

18. Chest compressions Infant <1 year Two finger method for one rescuer Hand encircling technique for two rescuers Child >1 year Two handed technique Heel of lower hand on lower sternum Second hand on top of first Elbows straight Shoulders over hands

19. Adrenaline Only use if enough skilled help to gain IV/IO access and give adrenaline Ventilation and chest compression must be continued throughout Dose 0.1ml/kg (10mcg/kg) Concentration 1:10,000 Dilute adrenaline 1ml with 9mls of NS Give adrenaline immediately and after every other cycle (every 3-4 minutes)

20. When to stop? Patient shows signs of life Does not show signs of life and the team agrees it is time to stop (20 minutes) Document Date Time Who present How many cycles Which drugs given Outcome Plan

21. Questions?

22. Summary Your facility must prepare for sick children and plan ahead When you suspect a child has collapsed, you must act quickly But you must act in a systematic fashion A irway assessment and support B reathing assessment and support C irculation assessment and support

23. Thank you so much for your attention!